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Association between Primary Hypercholesterolemia, Including Familial Hypercholesterolemia, and Abdominal Aortic

Kei Nakajima1,2, Airi Sekine1

  • 1Department of Nutritional Science, Food and Nutritional Sciences, Japan Women's University, Bunkyo-ku, Tokyo 112-8681, Japan.

Current Aging Science
|April 20, 2026
PubMed

Insights

Primary hypercholesterolemia (PH) and familial hypercholesterolemia (FH) are linked to aortic aneurysms, especially abdominal aortic aneurysms (AAA). This large-scale study highlights the importance of screening for these conditions in the general population.

Area of Science:

  • Cardiovascular Medicine
  • Genetics
  • Epidemiology

Background:

  • Primary hypercholesterolemia (PH), encompassing familial hypercholesterolemia (FH), elevates cardiovascular disease risk.
  • The relationship between PH, FH, and aortic aneurysms (chest aortic aneurysm [CAA] and abdominal aortic aneurysm [AAA]) is not well-established.
  • Investigating these associations in a general population is crucial for understanding disease prevalence and risk.

Purpose of the Study:

  • To investigate the associations between primary hypercholesterolemia (PH), familial hypercholesterolemia (FH), and the risk of developing aortic aneurysms (CAA and AAA).
  • To determine the prevalence of PH, FH, and aortic aneurysms within a large general population cohort.
  • To identify specific types of hypercholesterolemia associated with increased risk of aortic aneurysms.

Main Methods:

  • Utilized data from 8,995,522 individuals aged 40-74 years undergoing annual health checkups in Japan.
  • Defined PH, definite FH, probable FH, CAA, and AAA using medical insurance claim codes.
  • Conducted statistical analyses to assess associations, adjusting for confounders like hypertension, diabetes, and dyslipidemia pharmacotherapies.

Main Results:

  • The prevalence of PH (including definite and probable FH) was 0.18% in the study population.
  • PH patients showed higher rates of CAA (0.16%) and AAA (0.45%) compared to non-PH individuals.
  • PH, non-FH (familial-combined hyperlipidemia), and definite/probable FH were significantly associated with AAA (ORs 1.96-4.25, p <0.001) after adjusting for confounders.

Conclusions:

  • Primary hypercholesterolemia (PH) and familial hypercholesterolemia (FH) are significantly associated with an increased risk of aortic aneurysms, particularly AAA.
  • These associations were observed even within the general population, suggesting a need for broader screening.
  • The findings underscore the importance of managing lipid disorders to mitigate the risk of life-threatening aortic conditions.
Abstract

Keywords:
HypercholesterolemiaWald chi-square value.abdominal aortic aneurismdatabaseepidemiologyfamilial hypercholesterolemia

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